重度主动脉瓣狭窄合并肥厚型梗阻性心肌病一例  

Successful Multidisciplinary Treatment in a Patient With Severe Aortic Valve Stenosis and Hypertrophic Obstructive Cardiomyopathy

作　　者：王亮[1] 高力明[1] 黄晶 张奇[1] WANG Liang;GAO Liming;HUANG Jing;ZHANG Qi(Department of Cardiology,East Hospital,Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院心血管内科,上海200120

出　　处：《中国循环杂志》2023年第12期1297-1301,共5页Chinese Circulation Journal

摘　　要：主动脉瓣狭窄合并肥厚型梗阻性心肌病(HOCM)患者的治疗首选外科手术,本文报道一例患者应用经导管技术先行室间隔血管微粒球栓塞(PSEM)治疗左心室流出道(LVOT)梗阻后择期行经导管主动脉瓣置换术(TAVR)治疗的病例。患者为77岁男性,因活动后胸闷、气促入院,超声心动图检查提示跨主动脉瓣平均压差53 mmHg(1 mmHg=0.133 kPa),LVOT峰值压差93 mmHg。心外科评估手术风险极高。多学科讨论后决定治疗策略为先行PSEM解除LVOT梗阻,择期行TAVR治疗主动脉瓣狭窄。应用微粒球栓塞第一间隔支后LVOT峰值压差明显下降,6 d后行TAVR治疗,术后主动脉瓣压力阶差降为2 mmHg。患者病情稳定后出院。Surgical treatment is the first choice for patients with aortic stenosis(AS)and hypertrophic obstructive cardiomyopathy(HOCM),this article reports a case of a high-risk surgical patient who underwent transcatheter aortic valve replacement(TAVR)after undergoing percutaneous septal embolization with microspheres(PSEM)to treat left ventricular outflow tract(LVOT)obstruction.A 77-year-old male patient was admitted due to chest tightness and shortness of breath post physical activities.Echocardiography showed signs of severe aortic valve stenosis(mean gradient:53 mmHg)and HOCM(peak LVOT gradient:93 mmHg).The risk of cardiac surgery is extremely high.Multidisciplinary decision was reached in that PSEM strategy should be performed at first to relieve LVOT obstruction,followed by TAVR to treat aortic valve stenosis.After embolization of the first septal branch with microparticles,the peak LVOT gradient decreased to 15 mmHg immediately post PSEM.TAVR was performed at 6 days post PSEM,the postoperative aortic valve pressure gradient decreased to 2 mmHg.The patient was discharged without complications.

关 键 词：主动脉瓣狭窄 肥厚型梗阻性心肌病 室间隔消融术 微粒球栓塞 经导管主动脉瓣置换术 

分 类 号：R541.4[医药卫生—心血管疾病]